The Role Of Immunotherapy In Advanced Non-Small Cell Lung Cancer With Driver Gene Mutations

Lung cancer is a malignant tumor with the highest morbidity and mortality in the world,among which non-small cell lung cancer(NSCLC)is the most common type of lung cancer,accounting for 80-85% of all lung cancer patients.As the discovery of epidermal growth factor receptor(EGFR)and anaplastic lymphoma kinase(ALK)drive genes,the treatment of advanced NSCLC has realized the accurate treatment,targeted therapy is the first choice for advanced NSCLC patients with driver gene mutations,but almost all the patients undergoing targeted therapy face drug resistance.More effective treatments need to be explored.Immunotherapy is to stimulate the body’s own immune response to play an anti-tumor role,so that some patients can obtain long-term survival benefits.In recent years,inhibitors of programmed death-1(PD-1)and its ligand(PD-L1)have made great breakthroughs in the therapeutic model of NSCLC.Pembrolizumab,a PD-1 inhibitor,has been approved by FDA for the first-line treatment of advanced NSCLC with no driver gene mutations and the PD-L1 expression level more than 50%,besides nivolumab and atezolizumab have been approved for the second-line treatment of advanced NSCLC.However,it is one of the main problems to screen the dominant population of immunotherapy effectively.Immunotherapy is less effective in advanced NSCLC patients with driver gene mutations such as EGFR and ALK,but studies have suggested that the effect of checkpoint inhibitors is better than chemotherapy in patients with KRAS gene mutations.In this paper,I present a case of a advanced NSCLC patient with EGFR gene mutation,after 1 year of targeted therapy,found KRAS gene mutation,switching to immune therapy,and she achieved a stable condition,and further I discusse the role of immunotherapy in advanced NSCLC patients with driver mutations of EGFR、ALK、KRAS、TP53、STK11、MET and POLE.